In this interview, Rebecca Boss expands on her journey to her new (or not so new) position, and shares her vision for leading a state agency, with an eye on prevention.

You have worked at BHDDH for years. How is your role as Director different from your previous roles?

This November will be my 13th anniversary with BHDDH. I came in as the administrator for the substance use treatment unit. As Director, the role has changed significantly in that I have oversight of areas that beyond behavioral healthcare and greater responsibilities for Department management including roles related to legal and legislative affairs; communication; budget; and licensing. The role of Director includes oversight of the Division of Developmental Disabilities and the Eleanor Slater hospital. These are all huge operations with different populations and sometimes different priorities. As a person previously focused on program operations, the area that challenges me most is oversight of the budget, though I am fortunate to be surrounded by exceptionally capable staff with whom I work very closely.

My understanding of this role is that I cannot know everything, and I need to have strong people around me supporting the work so that I can rely on their expertise.
What are the key priorities for BHDDH under your direction? How does prevention fit into
those priorities?

My motto is “We’re going to do good things.” I think it is time for us to get back to the basics of what the department is charged to do. We have accomplished much in each of the divisions through targeted initiatives, but it is sometimes easy to lose sight of the broader mission when you are focused on specific programs.

We have a mission and a vision, but we need to have a common focus. I have areas of focus that are going to be guiding us in the next several years: access to care, person-centered care, community integration, evidence-based practices, and special populations.

I am a firm believer that prevention should be an integral part of public health, because the more we do in terms of wellness, mental health promotion, and preventing the onset of substance use disorders and other behavioral healthcare conditions, the less we have to do on the other end of the continuum. Universal screening and early identification is key. We know we are more successful with individuals who have an intervention early on as opposed to suffering the consequences of behavioral healthcare conditions that are undiagnosed, and under-treated or not treated at all. Prevention and early intervention is critical to the success of this department.

You can stand on river’s edge and pull people out of the water as they drown and call that success, but if you want true success you have to go up the river, find where people are falling in and fix it before it happens. To have a greater impact in the long run, we have to focus on prevention.

Why did you decide to accept your position as Director of BHDDH?

I have been with BHDDH for almost 13 years, and I have seen many directors. Each one has brought something different to the department, but there has been more transition than stability.

I accepted this position because I believe it was the right thing to do for the department in bringing stability, and it is much like the reason I accepted the job with the state in the first place. When I worked in direct care I had the benefit of working with people one-on-one and seeing and sharing in their successes. I came to the state with the expectation that I would have a broader impact on a greater number of people. By working with the state, developing good treatment systems, developing policies that improve our system, and being able to expand our healthcare – at that time focusing on substance use disorders – I knew I could impact the quality of services in Rhode Island. That is why I came to the state and why I took the role as Director.

In each phase of my career at BHDDH, I have widened the scope of my impact on a greater number of people. As Director, I get the opportunity to impact lives by creating better systems and better standards of care. I will lead the department in doing this by targeting the areas of focus and maintaining and fostering a deep understanding of our mission and responsibility to meet the needs of the individuals we serve.
What prompted you to move from substance use to behavioral healthcare?

Behavioral healthcare incorporates mental illness and substance use disorders. This department was well on its way to making sure we were merging behavioral health and substance use when I came to the department in 2004. Co-occurring disorders are so relevant. When you are thinking about a system of care for individuals, silo-ing mental health and substance use disorders is a mistake. They should be thought about collectively, because it is the system of care that you are really promoting.

When I first got here there was the behavioral healthcare division and it had a substance use unit, mental health unit, and a prevention unit. Recently, I reorganized so that there are not really separate units, but common functions. There is policy and planning, contracting that oversees contracts with providers, and community engagement. Instead of looking at the pieces that make up behavioral healthcare, we are looking at the functions that span across all pieces. That work started well before I got here. We are finalizing how that plays out, but there has not been a mental health unit and a substance use unit for a long time.

What are the major behavioral health challenges in Rhode Island?

Rhode Island has had an opioid issue for a long time. Heroin has been a drug of choice. The experience that the rest of the nation had in terms of the increased prescribing of opioids and then resulting deaths from prescription opioids only exacerbated the problems that were already happening here.

In some ways, the opioid crisis has drawn attention to the issues that we have been trying to deal with for a very long time, and that have continued to be some of the biggest challenges.

We have also had dwindling resources. There has not been as much investment in our mental health system – not just in Rhode Island, but across the nation. When we deinstitutionalized and moved people out of the Institute of Mental Health many years ago, there was a lot of money put in the community to make sure that individuals who had serious mental illness were cared for into the community. Over time, those resources have shrunk and that support from the community has diminished.

Another challenge is specialized populations. Youth are changing. We do not message to them well. Our system has not kept up with engaging and informing youth. We need to work more closely with some of our sister agencies in terms of planning for transition from Department of Children, Youth, and Families to our services. We need to ensure that we have the right kinds of systems and services in place to meet needs. Individuals with intellectual and developmental disabilities and co-occurring behavioral healthcare diagnoses are challenging in the system that we have now. We need to work closely with the provider communities to ensure that our system is keeping up with the needs. Historically, we have had a certain standard of care that we have tried to apply to everyone across the population. We recognize the need to change that approach.

Stigma is also a major challenge. There is stigma around behavioral health conditions and some of treatments for them . Particularly in the treatment of substance use disorders with medication assisted treatment. This is an evidence-based intervention, but some people are experiencing barriers to access because personal beliefs are thrown into the mix. This means they are not suffering from a stigmatized disease, but they are stigmatized if they get the treatment they need.

How can prevention community providers help you better address these challenges?

Addressing stigma has to happen on a community level as well as on a government level. We can talk to leaders in the community, legislators, and folks at the federal level, but if it is not happening in the community, then it will not have the kind of impact that we need.

Prevention and early intervention is key to us making progress. Prevention needs to broaden. It is mostly addressed in the school and it needs to expand beyond that. Prevention providers can help by thinking more broadly about their scope and their impact. Schools are important, but we need to reach people who have dropped out, are truant, work instead of go to school. What about elders who struggle with these issues? Prevention should happen throughout the lifespan.

Are there specific BHDDH resources or initiatives you would like to promote to prevention
community providers?

The prevention community needs to be aware of Healthy Transitions, which is part of the Now is the Time grant and is implementing a first episode intervention with at-risk youth or others in communities. We have also been working on the state youth treatment intervention grant in collaboration with the Parent Support Network to build and strengthen a peer and family based group to inform treatment.

Those are all areas I think the prevention community needs to be well aware of. I would add that we have been trying to work collaboratively with DOH because they are operating the Healthy Equity Zones and they are spearheading suicide prevention work. We as a department need to think about who our partners and stakeholders are; Prevention providers need to do the same thing.

Prevention communities should be working with the police and fire departments. They should be collaborating with the Health Equity Zones, the schools, and with providers in the community, because prevention incorporates treatment as part of the continuum.

Collaboration is important, because if we stay silo-ed, we are never going to accomplish the kinds of goals that I would like to see for this department and for our work in behavioral healthcare.

The Newport County Prevention Coalition is accepting applications for a part-time Assistant Director. The NCPC Assistant Director will work approximately 20 hours per week. This is a grant funded position and may be terminated if funds are eliminated. Grant funding is anticipated to be available from January 1, 2017 to December 31, 2021. The Assistant Director supports coalition management, community engagement, and supporting the coalition in carrying out prevention goals in the region. NCPC Assistant Director will have at minimum a Bachelors’ degree in human service, education, social work or related field. NCPC Assistant Director will have achieved at least the level of Associate Prevention Specialist (APS) Certification and will obtain the Certified Prevention Specialist (CPS) credential within 12 months of employment.

Additionally, Assistant Director will have a minimum of two years of work experience in the prevention field. The proposed Assistant Director is subject to approval of BHDDH.

Assistant Director must be able to work independently and maintain flexible schedule; must be available to work evenings and weekends when events dictate. Salary is commensurate with experience and certification.

In this interview, George O’Toole, Manager of the Anchor ED program at Anchor Recovery Community Center – Pawtucket, discusses the importance of peer support systems in recovery.

Tell me a little about the Anchor Recovery Community Center. What do you focus on? What services do you offer?

Peer recovery support is the chief service that Anchor offers. Our Recovery Coaches (RC) have the lived experience of addiction and recovery and can help others navigating the challenges of recovery for the first time. Each Recovery Coach builds what we call a “tool box,” which consists of resources that include detoxification centers, outpatient resources, medical assisted recovery (MAR), and various support groups that a person beginning or maintaining recovery might be interested in.

We also have employment specialists, who help create resumes and teach interview techniques. These services can be especially useful for those with substance use disorder who have served time.

Can you explain how Anchor defines recovery?

At Anchor, we like to say that a person is in recovery when they say they are in recovery. If a person says they are committed to recovery right now that is good enough for us, and we will do everything we can to help them stay on their path of recovery.

Tell me a little about what you do here at Anchor. What do you work on?

In 2014 when the overdose epidemic hit Rhode Island the Acting Director of BHDDH, Rebecca Boss, and Jim Gillen came up with an innovative idea. Why not meet people with substance use disorder where they are? They developed a proposal to initiate recovery coach contact in emergency departments and our AnchorED program was born. We started in only 4 EDs and now we are in all 12 EDs statewide. This is a big part of the work that I do currently.

What are some of the most significant challenges that people recovering from substance use and mental health challenges face?

Some of the biggest challenges these people face is finding employment and housing. Many of our clients have criminal pasts, and companies and landlords will not take them on. It is discouraging to invest so much of your time into the process of recovery and to continue to be denied opportunities to change your life. That is why places like Anchor are so important. We have resources to help people in recovery overcome those barriers. Our employment specialists do great work.

What partnerships are essential to work?

The city of Pawtucket in particular has been great. Mayor Donald Grebien and Pawtucket Police Captain Michael Newman have been champions of Anchor for a long time. They have collaborated with us to advocate for recovery support services in Pawtucket and throughout Rhode Island.

The Providence Center has also been supportive of us and our process. While they guide us and support us, they allow us enough autonomy to do our jobs the way we need to as a peer recovery organization.

How does Anchor work to address the opioid epidemic? What is happening with other RI partners? What are the biggest challenges? What are the most recent major successes?

Anchor does a lot of outreach and awareness work. We promote recovery and talk about substance use disorder on various commercials and on our public television program, Recovery Talks. Our biggest outreach and awareness event is the Rally for Recovery in September.

One big challenge in addressing the opioid epidemic is that people like to believe it does not happen in their communities. But substance use happens everywhere. No city or town or school escapes it.

A major success of Anchor’s is the Anchor ED program. Other states are starting to look at Rhode Island as a model for initiating peer recovery in the emergency department.

What recommendations would you have for community prevention providers working to prevent substance use in their communities?

It is so important to reach young people – those who already have experiences with substance use disorder themselves or within their families or circle of friends and those who have no experience at all. We need to do a better job reaching the next generation in prevention and treatment capacities.

Tell us about the youth treatment grant you are working on at BHDDH. What does the grant focus on?

It is a SAMSHA-funded federal grant that focuses on 12 to 25 year olds. We hope to build, fund, and sustain an integrated youth substance abuse program, including screening, referral, assessment, and evidence-based interventions and supports. We also aim to increase education in the workforce and raise awareness within schools and among parents. We are guided by principles and practices that are recovery-focused, person-centered, culturally-competent, and trauma-informed.

We are currently in the planning phase (2015-2017) and will apply for the implementation grant in the fall of 2017. There are a number of different components in our application, including a policy plan, a workforce map, a workforce training implementation plan, a provider collaborative plan, a family and youth involvement plan, a social marketing plan, a financial map, and a strategic plan.

Right now we are working on the developing an understanding of all the financial resources in the state that are dedicated to substance use and mental health treatment, regardless of the source. We hope to identify the gaps between what is provided to consumers and what is needed.

As a result of this gap analysis, we hope to improve the systems that support residential treatment, interagency referrals, and impaired driving policing. It has become clear to us that while RI treatment providers deliver high quality care, there are simply not enough providers in the state to meet the demand for this age group.

What types of collaborations are integral to your work? Who are your key community and organizational partners?

We are very interested in integrating all different perspectives and experiences into our strategic plan. When I first started, I tried to meet with everyone involved with youth treatment in the state. I looked up substance use providers in the phone book and called them for their input and to find out what services they offered. I then met with a number of different schools, particularly those without state-funded student assistance services, to determine what their needs were. I also reached out to prevention specialists. And of course, all related state agencies are involved.

I strongly believe that it is very important to include everyone’s voice in this process. Whenever I encountered an opinion that was different than my own, I invited that person to be part of our advisory group. We want people who both agree and disagree. Health debate is so important.

One of our recent successes was a community planning retreat. Fifty people came out to give their opinions!

What populations does the grant emphasize? What are some of the challenges associated with these populations?

The grant is interested in all youth ages 12 to 25, regardless of their insurance classification. So this includes both Medicaid and youth covered by private insurance.

Early on, we decided to break the age range into two categories: 12-17 and 18-25. The first age group encompasses individuals below the legal age and the second group is more of a transitional period for youth, between childhood and adulthood. We would like to create treatment programs specifically for transition-age youth that reflect this reality. That way an 18-year-old does not have to be in a treatment program with someone who is 55 and at an entirely different stage of their life.

The challenges youth face really depend on their life status, which can vary widely between individuals. Different considerations must be made for youth based on whether they are homeless, in school, and/or working. In all cases, youth need to be met where they are. And that really depends on the circumstance.

What do you see as the role of prevention in addressing youth substance use in our communities?

Prevention is the key step. If we could stop early use, that would go a long way in reducing substance use later in life. I strongly believe in focusing efforts upstream. Whatever falls through the cracks, it is treatments and recovery supports job to pick up.

What key information would you like to share with local prevention providers around youth substance use?

We find that there is so much misinformation out there with youth these days. Not all youth understand the basics of drugs and their impact on the body. As result, we really support the great work that prevention providers are doing to educate our youth. The more campaigns we have that spread education and knowledge, the better.

Gaby Abbate, Chief of the Office of Highway Safety at the RI Department of Transportation

Tell us about the Office on Highway Safety at the Rhode Island Department of Transportation (RIDOT). What are the responsibilities associated with your office?

Our goal at the Office of Highway Safety (OHS) is to save lives and prevent serious injuries by reducing the number of traffic crashes in the state. We take a global approach to prevention and safety by focusing on environmental strategies to influence roadway behavior. We implement media campaigns, review State and municipal policy and public ordinances, support education and curriculum development, and organize outreach efforts across the state. We are data driven, allowing us to target specific behaviors with directed programs. We target risky behaviors like speeding and impaired driving, and the groups that are identified as risk-takers.

Roadway use is one of the most common denominators for every family and visitor in this state. Everyone uses the roads, whether we drive, walk, or bicycle. As a result, our office approaches roadway safety from many different perspectives—including the vehicle driver, the vehicle passenger, pedestrians, young drivers, seniors crossing the road, and infants being driven home from the hospital for the first time.

Let’s talk about impaired driving in Rhode Island. What are you seeing?

One third of all fatal crashes in Rhode Island are related to impairment. For a long time, our demographic data identified 18 to 35 year old males as the group we needed to focus our prevention efforts on. Recently those identifiers have shifted to include an older demographic—26 to 50 year old males—so we are correspondingly shifting our target and strategies.

What is the Rhode Island Department of Transportation doing to prevent impaired driving?

In line with the new data trends, we are implementing some new programs for adults. We are developing an initiative for local businesses which includes educational sessions focused on impaired driving. We are calling them ‘Lunch & Learn’ sessions. Colonel Steven O’Donnell, Superintendent of RI’s State Police will deliver both an enforcement message and a safety message. We’ve found that you have to meet people where they are. It is difficult to reach people at night for a meeting when there is so much else going on in their lives.

We have also recently created a task force called the Impaired Driving Prevention Alliance. Three State Troopers have been assigned to the Office on Highway Safety to support the Department’s impaired driving goals and strategies previously approved by NHTSA. They will work in a coalition model to promote policy, media, and programs to eliminate impaired driving in our state.

The OHS provided funds and support to allow the City of Providence to purchase a mobile command center to help with municipal and state law enforcement’s DUI patrols. Providence offered to be the central repository for the command center and bring it into any RI community to help with their efforts as well.

We are also implementing a new crime and traffic safety initiative called Data Driven Approaches to Crime and Traffic Safety (DDACTS). It allows us to overlay crime and crash data on a map in order to determine where to deploy police. As we are a small state with limited funds, it is very important that we are data driven and allocated our resources appropriately.

RI DOT’s new Director, Peter Alviti, Jr is in complete support of all our safety efforts, whether they are structural or behavioral. The director has fostered a strong relationship with Colonel O’Donnell and Department of Health Director Alexander-Scott in order to demonstrate the department’s belief in partnerships and leadership.

What role do the DOT Community and State Stakeholders play in prevention? Who is represented within this workgroup?

Partnerships are very important to our work. It’s the only way we can make all the dots connect and stretch our funding dollars. Our NHTSA funding allows us to award grants to our partners in the community. Any non-profit, state agency, or municipal agency is allowed to apply for these funds as long as their proposal is focused on roadway safety, has tangible deliverables, and includes appropriate evaluation, outcome, and performance measures. In the past we have supported media campaigns, law enforcement details, and community activism. We convene the stakeholder group so that our grantees and other stakeholders can meet and work together.

Are there any prevention strategies you would recommend to community prevention coalitions?

Environmental strategies are key. Towns and cities would also benefit from looking at their ordinances to make sure they are incentivizing the right behavior. Allowing town employees time to be educated around these issues would also be helpful.

Ultimately, it starts in the family unit. It’s not just the responsibility of the state. Parents need to educate their children on safe roadway behavior, whether they are driving, riding, or walking. Parents need to model safe roadway behavior. Community coalitions can help facilitate that through education and media messaging.

In this interview, Sarah Dinklage, the Executive Director at Rhode Island Student Assistance Services, discusses the importance of school-based prevention.

Tell me a little about the Rhode Island Student Assistance Services. What does your organization focus on? What is the primary population that you work with?

Rhode Island Student Assistance Services (RISAS) is a division of Coastline EAP. We were established in 1987 as a pilot student assistance program based on a SAMHSA evidence-based model in 7 RI high schools. We are now serving 45 schools in 25 districts. Our mission is to provide community and school-based prevention services to youth and reduce substance use among people ages 12 to 18.

Our core service is the Student Assistance Service based on the Project SUCCESS model—an NREPP-listed SAMHSA program with components for all students (universal), those at higher risk than the general population (selected), and those that have a history of substance use (indicated). It is a school-based model meaning that kids have easy, confidential access to specially-trained professional throughout their school day. We also try to make it as adolescent and consumer-friendly as possible.

What types services do your counselors provide to students, teachers, and administrators?

Our student assistance counselors teach a classroom-based prevention education series. It is an eight session curriculum designed to educate kids about substance use and the impact of family addiction. It also provides students with exposure to the student assistance counselor in a non-threatening, non-stigmatizing manner. The student assistance counselors also run schoolwide awareness activities that vary from school to school—including Alcohol Awareness Month, the Great American Smokeout, and Suicide Prevention Week.

Student assistance counselors also provide confidential short-term individual and group counseling services for students on an as-needed or referral basis. Students are welcome to come by to talk about any problems that concern them, whether they are related to substance use or not. It is very important that the program is not stigmatized as the “drug program” as that might inhibit students from seeking help. Students can also refer a friend by letting the counselor know they are worried about someone. Some students are also connected with the student assistance counselor through a ‘mandatory referral’ if they have been caught under the influence at school and face disciplinary action. Counselors then do a comprehensive assessment and use practices like Screening, Brief Intervention, Referral to Treatment (SBIRT), motivational interviewing, and stage of changes to assess for services needed and can refer the student to outpatient or inpatient treatment if it is warranted. Often, if a student needs treatment, the counselor will also meet with parents and family members to provide additional guidance.

Student Assistance Counselors also run a number of different types of support groups for students in their school. There are groups for kids motivated to work on their substance use, groups for those who don’t see it as a problem but are willing to talk about other things, groups for children of drug and alcohol abusing families who are using themselves and groups for children of those families who are not. There are even groups for seniors struggling with life after graduation and groups for newcomers to the school.

In addition, counselors are responsible for community and parent outreach and education. This includes newsletters, editorials, email messages, maintaining listservs, making presentations, conducting workshops, and organizing community forums. We even have some who are talented in social media.

Do you partner with other organizations? What types of collaboration are integral to your work?

We work very closely with public and private treatment providers in the community as well as other social service organizations that help young people. Student assistance counselors must be very knowledgeable about the resources in their community. We also partner very closely with substance abuse community coalitions. Our counselors work on committees and execute a lot of the activities that the coalitions help to fund or are coordinating. For example, if a community coalition wants to have a varsity athletics against substance use club, the student assistance counselor can co-advise that club with help from the coalition.

Our other two important partnerships are with the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH) and with the Department of Health (DOH). BHDDH funds Project SUCCESS and DOH contracts with us to implement a statewide suicide prevention program.

We also really appreciate the support of the school administrators we work with. They understand the importance of community partners, like us, in making sure that kids are sober and ready to learn.

What are your most significant challenges currently?

Our biggest challenges are (1) the changing policies, laws, and climate around marijuana and (2) the increase in heroin use and prescription drug abuse. However, we are seeing an increased interest among schools and our congressional leaders to improve the delivery of substance use prevention in schools.

What prevention-related successes has RISAS had recently?

I am very proud with our 30 year partnership with Rhode Island schools. The fact that we have been able to establish such a long partnership with Rhode Island school districts to implement substance abuse prevention is a big success. And, most recently, I am very proud of our new prevention education series—a new curriculum for us. But I am most proud of the dedication, knowledge, skill and passion of our Student Assistance Counselors, many of whom have been with us for over 15 years – they have positively impacted countless young lives.

In this interview, Pat Seltzer, a Community Wellness Nurse at Buttonwoods Community Center & Pilgrim Senior Center, discusses prescription drug misuse and abuse among older adults.

Tell me a little about the Pilgrim Senior Center & the Buttonwoods Community Center and what the organization is focusing on.

Mayor Scott Avedisian has always been the City of Warwick’s leading advocate for Human Services. The Pilgrim Senior Center & the Buttonwoods Community Center aim to provide a safe and nurturing environment where the senior community can congregate for programs and activities and also receive health and social services related resources and referrals. I work as the City’s Community Wellness Nurse, and, along with the social services team, provide on-site assessments on an as-needed basis. Seniors come in to see me with various requests including first-aid, requests for biometric screenings (blood pressure, blood glucose, BMI), and occasional requests for over-the-counter drugs like Tylenol. Our doors are always open.

What are your concerns around prescription drug use at your two centers?

We see much more prescription drug misuse than prescription drug abuse. In fact, I can’t remember a time where our services were sought out for substance abuse. I think that has a lot to do with our audience—most are active and vibrant.

However, prescription drug misuse is something that we see frequently. Regardless of the initial reason for their visit, I always ask about medications during health assessments. What kind of medications are you taking? How long have you been on those meds? Do you feel like they are doing their job? Do you need more of them?

I find individuals who are accidently taking both the brand name and the generic of the same drug, individuals who are splitting doses because they can’t afford their medications, and individuals who are sharing medications with friends. Most of our seniors are on a fixed income – with the rising cost of medications, many are looking for new ways to save.

How are you addressing prescription drug misuse among older adults at the Senior Center’s in Warwick?

Beyond my health assessments that discuss medications, we are very fortunate to partner with the University Of Rhode Island College Of Pharmacy Outreach Program. Every month, they come in to do a workshop on a variety of issues related to medication use. As part of their outreach, the pharmacists conduct individual “brown bag” program visits and have been known to sit with a client for hours to help them understand their medications. They talk about each individual’s medication: prescription and over the counter (including supplements), how to setup a schedule, how to save money on prescription costs and, if necessary, how to not fall for advertisements falsely claiming that homeopathic supplements can replace their prescriptions.

What are the biggest challenges facing communities and states in regards to older adult prescription drug abuse?

The need for outreach and education is a big challenge for all communities. Older citizens would be better served by consolidation and utilizing the resources saved to dispense a united approach for outreach, education and resource referral.

What is being done on a local level to prevent prescription abuse and misuse within the older adult population?

We also have a 24/7 drug take back program, whose initial funding came from BHDDH, housed at the Warwick Police Department—in the lobby. Any unneeded drugs are collected and destroyed. It doesn’t accept liquids or needles but AIDS Care Ocean State will take the needles. They may even pick them up at your home.

Has Rhode Island had any major successes related to prescription drug abuse by older adults?

I have been a huge advocate for the prescription monitoring program which has mandated additional training and reporting for physicians who prescribe opioids. I am really excited that it is finally finding its home. However, it does need to be tweaked. Some seniors are offended by the nature of some of the questions they are required to answer in the “Pain Contract” such as “are you giving your meds away?” and “are you selling your meds?” Others, who have been maintained on medication long-term for a chronic pain condition, are worried about their doctor’s disrupting their equilibrium. But in general, I think in it’s a great idea—the physicians who were at first a bit careless about opioid prescriptions are now required to think about it a little differently. Hopefully that helps get this stuff off the streets.

In this profile, Jeff Hill talks about the Rhode Island Youth Prevention Project (RIYSPP) and their work to educate the public about youth suicide and effective prevention strategies.

Tell me a little about suicide prevention at the Department of Health and the RI Youth Suicide Prevention Project.

The RI Youth Suicide Prevention Project (RIYSPP) was “born” in 2009 at the Rhode Island Department of Health through a federal grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) and through funding from the Garrett Lee Smith Memorial Act for state youth suicide prevention programs. The project provides a safety net for at risk youth by instituting screening, identification, and referral protocols, training gatekeepers, and providing a media campaign about who is at risk and how to respond. For example, through the conclusion of the grant in 2019, we expect to train up to 42 public schools as gatekeepers in the suicide prevention protocol Question, Persuade, and Refer (QPR) and work with four middle schools and four high schools training students in Signs of Suicide where they will learn to Acknowledge, Care, and Tell (ACT) a trusted adult if they are concerned about a peer who may be expressing signs that they are in distress.

RIYSPP has many partners, including Rhode Island Student Assistance Services (RISAS), Access Center at Emma Pendleton Bradley Hospital’s Kids’ Link, the VA and National Guard Suicide Prevention Programs, Brown University’s School of Public Health, and the Brady Center to Prevent Gun Violence.

What do you think are some of the most common misunderstandings about youth depression and suicide?

One of the most common myths or misconception people have about suicide is that talking to someone about suicide may give the idea to do it. The truth is that giving that person the opportunity to talk about these thoughts can create an immediate connection that can give them a way to communicate their fears and express their pain without resorting to self-destructive behaviors. Furthermore, many believe that those that talk about suicide won’t actually do it and are just trying to get attention from others. In fact, studies have reported that as a many as three quarters of people who attempt suicide have said something to someone or reached out in some way for help, even posting on social media. Their comments should get people’s attention, because they need help.

Most of those who attempt suicide don’t actually want to die, but they do want the pain they are experiencing to stop. It is so important to connect them with help. One way would be to use the National Suicide Prevention Lifeline, which is answered locally right here in Providence, by calling 1800-273-TALK (8255).

What is being done on a local level to implement suicide prevention initiatives?

Since 2009, the RIYSPP held trainings for well over 2,000 gatekeepers throughout the state including community based and social services organizations, middle and high schools, universities and colleges, first responder agencies, and other state agencies. The project has worked with four different school districts providing gatekeeper training for over 500 high school students. We continue to reach out to schools, colleges, businesses, and others to spread the message that suicide is preventable and help is available.

Some of our other recent projects include…

RIYSPP worked with the Providence Veterans Administration Medical Center’s (VA) Suicide Prevention Program to provide over 100 gun locks for distribution to families who may have a child in crisis and an unlocked gun in the home through the Bradley Hospital Access Center.

RIYSPP and the Brady Center to Prevent Gun Violence co-created the nationally promoted website suicideproof.org to provide simple tips to reduce the access to lethal means in the home.

RIYSPP partnered with a local university to place 2500 refrigerator magnets in residence halls.

What are some key suicide prevention strategies for community coalitions, schools, and parents?

There are many education programs available in the state of Rhode Island for students, teachers, first responders, healthcare workers, and community members who wish to learn how to help prevent suicide. Some healthcare plans, like United Healthcare, offer Question, Persuade, and Refer training online that is free.

A personal strategy that any family in Rhode Island can use is to limit the access to lethal means in the home. There are many tips on our Suicideproof.org website of simple things you can do to reduce risk. For example, locking up a gun if it is in the home, removing the gun from the home, locking up medicine cabinets, or removing old medicines by using the drop box located at many local police stations.

What are Rhode Island’s major successes related to suicide prevention?

I think our most important successes are the relationships that are being formed and the amount of collaboration that is taking place as a result of our work. We continue to build on our relationships with our National Guard and VA counterparts and we continue to support our statewide coalition that has over 60 members from many different individuals, community based organizations, grant funded partners, and state agencies.

Any other important messages you would like to share?

Don’t be afraid to pick up the phone for yourself or a loved one. Prevention is so important to our work. It is critical to recognize the signs or symptoms that someone may be thinking about harming or killing themselves, be able to ask them if they are ok, and then refer them for professional help. TheNational Suicide Prevention Lifelineis open 24 hours a day: 1-800-273-TALK (8255).